I'm a breastfeeding counselor with a side hobby in educating parents and caregivers in proper car seat use. I have four sons, one born by c-section and three born by VBAC. I blog about my life with four kids, pregnancy and birth, breastfeeding, and car seats.

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Friday, August 30, 2013

I find myself, with about eight weeks left of this pregnancy, suddenly terrified of having a newborn again. This happens with each consecutive child. I cycle from excited, to thinking we must be crazy, to content, to excited, to terrified, to content, to excited, to OMG WHAT WERE WE THINKING?, then back to excited, then content, then terrified.

Part of it is our kids are spaced just-so, that we finally are at a point where sleep is basically working, routines are basically established, everybody's got some level of independence, and I feel like I'm in the groove, and then we throw another newborn into the mix and everything gets thrown out of whack again. And this being my fourth time through the ringer, well, I kind of do know what to expect.

In some ways, knowing what to expect is comforting. I know what to do with a newborn. I know phases start and phases end. I have almost seven years of watching kids grow up under my belt and have been through sleeplessness and teething and illness and firsts and potty training and nightmares and picky eating and tantrums and I know that "this, too, shall pass" is an absolute mantra of parenting. I know I can stick it out for a little longer until one problem ends as suddenly as another begins. I can pass along the sage wisdom of, "Just when you think you have it all figured out, they change it up on you again," and I can remember it for myself. I know that "do what works," "wait it out," and "give it another couple weeks" are absolute truths. I know that every kid is different, that every baby needs love, and that I have the strength and capacity to make it through this hour, this day, this week.

But in other ways, knowing what to expect is terrifying! I know about the sleepless nights, the crying for no reason (both me and the baby!), the stress of feeding issues and poo-splosions. I know about the pain of recovering from childbirth. I've experienced the complexities of balancing the needs of the older kids and the baby, and the sheer exhaustion of new parenthood. (And it's still new, even when it's for the fourth time.) I know about the disruption of routine, the randomness of life with a newborn, and the stress of evening fussiness. I know that sleepless nights and teething woes are once again on the horizon.

I find I do have a longer view than I used to. I'm already thinking about next fall, when my second will start kindergarten, my third will be three, and the new one, who is right know kicking and dancing within me, will be almost one. Because I can envision that, when it used to seem impossible that my kids would ever grow up, grow bigger, start school. It used to feel like toddlerhood was forever, that I'd be always wiping butts and noses (not simultaneously), cutting up food into tiny pieces, and washing sippy cups. Now I see that it is not. That life will change. That one day my days will be my own (except for school breaks and sickness), that my kids will be helpful in stores, that I won't have car seats to buckle or diapers to change, that I won't have to supervise trips to the bathroom, that as suddenly as life changes when you give birth, life gradually evolves again as that baby becomes a little person who walks and talks and has opinions all his own.

So, I'm terrified of the short term, of what I know is coming in the next few months and years. But I'm excited, too, about the long term, of watching another bright soul come into his own, of seeing our once-little family become huge and full of life and noise and warmth and love.

To those of you out there with one little one, or two little ones, who see life at knee-height, whose days are full of poop and whose nights are empty of sleep: give it a few weeks, months, a year. Life will expand. Your kids will grow. You will grow. You have the strength to make it through this hour, this day, this month. And while you may not look back fondly on every tantrum (yours or theirs), you'll look back and know that the weeks are shorter than they seem and that the months go by faster than you could ever have imagined.

Monday, August 26, 2013

Today, I put my 4.5-year-old's car seat in my neighbor's van and watched her kids climb into their car seats in the back row. I, of course, installed my car seat securely, fastened the top tether, and buckled my son in as usual, with a nice, tight harness and properly aligned chest clip.

Her kids, almost-3 and almost-5, are in good car seats, a Britax and a Graco, both five-point harnesses. But they were not buckled safely. The harness was too loose, the chest clip was not remotely in the right place, and the straps were twisted. On top of that, she has the same van as me, and I know that there is only a top tether hook in the center position in the back row, so really she shouldn't have had her daughter's seat on the side, either, since the top tether couldn't be secured.

It's so hard to know where to draw the line about when and whether to allow your child to ride in someone else's car. I trust her driving; I trust her parenting; I trust her to keep my child safe as they go on an adventure together. Knowing that I installed my son's car seat and buckled him, at least for the first leg of their drive, I know he's fine in the car.

But I also know that her kids are not buckled correctly. So we have one of these, "Do I say something or not?" moments. Should I tell her that her kids are not really secured safely? Should I offer to check her car seat installation for her? She knows I'm big on breastfeeding, and in fact asked me for some advice regarding her seven-month-old a few weeks ago, so if she knew I also was obsessed with proper car seat use, would she ask me for advice about that as well?

I've run into this a few times, where I just want to help a friend, but I don't want them to take my information as criticism of their parenting. And what do you do when someone asks you for help, takes you seriously, but then continues to do it incorrectly? I've had that happen, too!

So what would you do? If you were the one doing the driving, making the offer, how would you feel about the other parent mentioning something about your car seats or the way your kids are secured? If you were the one whose kid was being driven by someone else, would you say something to that parent about their kids' safety (and, by extension, that of your own child)? I don't want to be "that mom," but car accidents are no joke.

Tuesday, August 20, 2013

Car seats are too complicated. This is the conclusion I've come to. Most people do not install their car seats correctly. The ones that are aware of this demand to have their seats checked by a professional, but often the "professionals" are not certified either. Most people who do not install their seats correctly don't know that they haven't installed them correctly. On top of that, most people don't use the car seat properly once it's installed, compounding the problem.

All of this leads me to just one conclusion: car seats need to be simpler. People look forward to their kids growing out of car seats because they understand seat belts and how to use them, and they're pretty darn straightforward. We don't want to have to mess with LATCH, belt paths, chest clips, expiration dates, weight and height limits, cleaning instructions, and rules of installation and after-market accessories, especially when so many of the rules vary from car seat to car seat.

When something is simple, relatively foolproof, there's a much greater chance that it will be done correctly. Computers have gotten pretty easy to set up, because each cable can only fit into one slot, and everything else has a standard connector. TVs and their corresponding attachments (DVD players, for example) have color-coded cables so you know where to stick what. Batteries are standard sizes and shapes and are clearly marked. The nozzle on a given gasoline pump will fit in any given standard gasoline-powered car. Indeed, most safety-related features on a car are made to be relatively foolproof. The gears are always in the same order on an automatic transmission shifter (P, R, N, D...) and generally the same on manual shifters as well. The turn signal lever is on the left side of the steering wheel. The gas pedal is on the right, the brake is on the left (or in the middle, with the clutch to the far left if you have one).

My point is, companies try to make things easy on consumers, particularly because consumers are well known not to read manuals, to forget information they are presented with, and not to be willing to learn too many new things. And, let's face it, some consumers are not capable of understanding or remembering complicated instructions.

Why, then, are car seats not simpler? Why, with this item we trust the safety of our children to, are we expected to learn lists of rules to follow? Why is it so easy to screw it up? We are told to trust our common sense in so many things regarding child-rearing, and we have plenty of help around for everything else - doctors for help with illness and accidents, teachers to help our kids learn things we don't necessarily know ourselves. But car seat technicians aren't so easy to find, and, frankly, many people don't know they should seek one out. I mean, it looks easy enough: hook this thingy to that thingy, then put that tab into that clip. And, really, it should be that obvious, and it should be that simple.

Car seat technology has come so far. A lot of engineering goes into the design of a single child restraint. We want our children to be safe, and we want to be able to trust car companies, car seat manufacturers, and government agencies to have our kids' safety high on their list of priorities.

So, to those agencies and companies: let's take the next step in child restraint technology. Let's make it easy and foolproof to purchase, install, and use the right car seat for the right child in the right manner. What if the harness tightened automatically, much the way a seat belt retracts automatically after we buckle it and then auto-locks in a sudden stop? Couldn't car seats have standard connectors that fit all cars the same way? (LATCH attempts this, but research has found that LATCH doesn't always actually make the installation more correct or simpler, because car manufacturers don't put them all in the same place or make them easily accessible.) There must be a way to properly position the harness straps without the infamous chest clip; they do it in Europe, after all! Shouldn't we more clearly and honestly display weight and height rules for a given car seat? Shouldn't we standardize car seat laws across the 50 states to more closely match the recommendations of the NHTSA, the AAP, and car seat safety experts? Can we make good car seats more affordable? Let's make crash test data more accessible to the consumer, in the same way a consumer can easily see the crash test ratings for the car they want to purchase. Is there a way to build the car with kid-sized safety restraints built-in? A few models out there have build-in booster seats; could we take that to the next level and include 5-point harnesses for older toddlers and younger children?

What other ideas do you have for improving the usability of car seats? What can we encourage manufacturers and engineers to work on next, so that proper use of car seats is more universal and the end goal, of kids being safer in cars, is better met?

Sometime reasonably early in your pregnancy, perhaps in the first part of the second trimester, you'll want to start thinking about who will be there at your birth. For many women, it's a no-brainer: the father of the baby should attend the birth. For others, the father may not be present, there may be no "father" in a parenting sense, or the father may not be able to attend due to circumstances out of his control, such as being deployed with the military. In other cases, the pregnant woman's partner may simply feel inadequate to be fully supportive or may be unwilling to try. Other partners may simply feel that having someone else there who knows what labor and childbirth should look like may be helpful.

That's where a "doula" comes in.

Realistically, it's only in the past maybe 40 years that the father of the baby has been expected to be anywhere near the birthing room. Birth, historically, has been the domain of women. A laboring woman's mother, older sisters, aunts, or other women in her life who have been through childbirth would traditionally attend her, as would a trained midwife, typically. Even when male doctors started attending births, fathers waited outside. Today, most fathers desire to be in the birthing room, supporting the mother of their child and meeting their new baby right away, and most new mothers want the father to be there.

In all cases, there is no question that a woman was never expected to get through labor alone.

The word "doula" comes from the Greek meaning "a woman who serves." Today, the term doula generally refers specifically to a woman (or occasionally a man) who attends a woman during her labor, providing physical and emotional support, helping her understand the birth process and what's happening to her, assisting her in communicating with her partner and her care providers, and helping her to make informed decisions throughout the labor and delivery process. The term doula is a professional title for someone who has been trained in this arena, but in terms of the more casual use of the word, a doula is anyone a woman chooses to be there to support her as she labors.

It is important to remember that a doula is not a medical provider. A doula does not check vital signs, administer medications, check cervical dilation, or make recommendations or medical decisions on behalf of the mother, and she does not deliver the baby. A doula is a support person who understands the birth process and can help the laboring woman manage pain using non-medical techniques such as breathing and relaxation. Some doulas have specific training in areas such as massage, aromatherapy, or acupressure that she can use to offer other types of relief as a woman labors. A doula's primary role is to provide information and emotional and physical assistance. A doula is in constant attendance and is there solely for the sake of the mother.

Why Might You Want a Professional Doula?

While anyone can technically act as a "doula," such as your mother, sister, or best friend, a professional doula will have specific training in how to support a woman in labor. She will have knowledge and an understanding of the birth process. She will be a steady presence, someone who has seen birth and knows what's going on who can offer perspective, information, and help the mother make informed decisions when presented with choices by her care provider. She can help the mother and her partner develop a birth plan or decide on birth preferences and come up with alternatives in case of unexpected events. A professional doula, more than anything else, will be a source of reassurance and strength during this exciting and frightening event and will act as a mother's advocate in the medical setting, and she will be able to be with the laboring mother at all times, while the medical personnel are generally in and out over the hours. A doula can also support the laboring woman at home and help her decide when it is time to go to the hospital, enabling her to spend more time in the comfort of her home and not set off in a panic to the hospital the moment the first contraction hits.Professional doulas have specific training and are required to attend several births before receiving their doula certification. Doulas are certified by DONA International and may use the initials CD(DONA) after their names. See www.dona.org for more information about DONA and how doulas are trained and certified.

Why Might You Not Want a Professional Doula?Not everyone has a doula at her birth, and not everyone wants one. You may feel that you know enough about the birth process, or you trust that your partner or another family member or friend will be sufficient support that you don't want or need to seek out a professional. For many, there are also financial considerations. While most women who have had a doula at their birth will tell you it is money well spent, a professional doula typically charges anywhere from $700 to over $1,000, depending on her services, experience, and your region, and this is generally not covered by insurance. Finally, some women or their partners are uncomfortable with the idea of having essentially a stranger attending such an intimate experience in their lives, or they feel that one more person in the room will be one more too many.I should note that if finances are the main reason you are not considering hiring a doula, you can often find doulas who are willing to work with you on a payment plan, as well as doulas-in-training who may be willing to negotiate a reduced fee. There are some doulas who donate their services on occasion, depending on the circumstances, and there are some hospitals (a few) that may have a volunteer doula program where doulas will attend your birth at no additional cost to you. The disadvantage to this last option is that you wouldn't get to meet her in advance and become comfortable with her. Please remember that for a professional doula, attending births is her job as well as her passion, and she will be spending many, many hours with you as you labor, often through the night, both at home and in the hospital or birth center, and it is not fair to expect her to do it for free.

If your major concern is the idea of having a stranger with you, keep in mind that you will meet with your doula a few times before you go into labor, and you should only choose someone that you feel comfortable with. Your care provider and the nurses who attend you (if you deliver in a hospital) will also be relative "strangers" as well, if you think about it.Many women do not hire a doula either because they don't know it's an option that exists or because it seems too "hippie" and nontraditional. Women who choose to have a doula attend their birth are still a small percentage of all birthing women, but the number is growing. Studies have shown that women who have a doula with them at their birth report more positive feelings about their births, shorter labors, and healthier outcomes for mother and baby. Thoughts from Two Professional DoulasI interviewed two professional doulas to get their perspective on what their role is. Jenna Anderson and Jessica McGuire are San Diego-area doulas who were kind enough to participate in the writing of this article. Jenna and Jessica were both inspired to become doulas after the births of their first babies. Jenna did not have a doula in attendance, but after the long labor she realized how helpful it would have been to have another support person as she labored, especially so that she wouldn't have been left alone through so much of the labor process. She decided that she would like to become a doula to provide that kind of support to other laboring women. Jessica did have a doula with her at her first birth. Though she found her birth to be quite traumatic, she reports that her doula was very encouraging and reassuring as labor progressed. She remembers a line from More Business of Being Born that said that doulas are natural born teachers and realized that this was her calling.I asked Jenna and Jessica to describe, in their own words, what a professional doula does. They both responded that their role is to provide information, support, encouragement, reassurance, and advice to the laboring woman and her partner. Jessica stressed that her advice should never be unsolicited and both Jenna and Jessica stated that they adjust their role and how hands-on they are based on the needs of the individual woman they are with. I then asked what they are not supposed to do. Both mentioned that they specifically cannot and do not speak for the mother, nor can they provide any clinical or medical services such as cervical checks or fetal heart monitoring. They both again stressed that their role is support, information, and reassurance.Jenna and Jessica described some of the methods they use to help a woman relax and cope with contractions. They may use essential oils, massage, hot water bottles at specific points on the body, and they may suggest different positions and movements and, of course, offer verbal encouragement and emotional support. Jessica also mentioned that she has received certification in the use of a TENS unit to help with pain management.Jenna's website is thebirthofadoula.blogspot.com and Jessica can be found at www.agapebirthandbeyond.com.

Monday, August 12, 2013

Until we moved, we regularly attended synagogue on Saturdays at our local Chabad house. When we moved, one of our many tasks was to find a new place to go on Saturdays, so this weekend, we visited one of the Chabad houses within a reasonable distance of our somewhat isolated new home.

This particular Chabad house has their services and offices located on the first floor of a commercial office building. They showed me and my kids to a room where they could play while my husband joined the prayer service. They said usually other kids start coming a bit later. I didn't want to leave my kids alone there without supervision, so I hung around with them while they built with Mega Blocks and Duplos.

The thing about Saturdays is, it's the one day a week that my phone is not in or near my hand. Because it's Shabbat, the day of rest, the use of electricity, telephones, televisions, etc., is customarily avoided. We are not particularly strict about the laws of Shabbat at home, but when in synagogue, out of respect for the day and the people around us, we leave all of that in the car and assume the sacred space of Shabbat.

This meant that, for a while, I was extremely bored and found myself reading a copy of "Mrs. Piggle Wiggle" that someone had left lying open on the couch just outside the room where my kids were playing. After some time, I wandered in to the room to see what they were up to, and I found my almost two-year-old son, G, playing with a plastic tea set, pretending to pour coffee into a mug. He "drank" some of the coffee, then offered some to me. I sat down with him at the table. Soon, my 4.5-year-old son S joined us and started making "soup" in one of the plastic bowls. Then the 6.5-year-old, N, came to see what we were doing. S told us he was making soup and then pretended to pour coffee and tea into the "soup" bowl. N and I said, "Ewww!" and asked what kind of soup it was before the coffee and tea were added. S informed us it was "tuna soup." "Eww!" we said again. We then took turns coming up with the weirdest and yuckiest-sounding soup recipes we could think of. Adding chocolate syrup to almost any savory soup seemed to be the "ew" factor of choice.

The wife of the rabbi appeared with her daughters, greeted us, and told N she might have some Lego around if he wanted. She couldn't find the Lego, but she did find more pieces to the tea set and some toy pots and pans with which we could continue to make soup. G was delighted to find another spoon and a fork to go with the one spoon we had uncovered at first. We spent quite a while making crazy soup concoctions and pretending to eat and drink.

Normally, when I do get down on the floor (figuratively or literally) to play with my kids, I get bored pretty fast. I've learned I'm not alone in this - some have a greater tolerance for the repetition and simplicity of toddler games than others. My style is usually to be nearby but watching, rather than participating in, the play. My three are pretty good at playing together and finding things to do, but an almost-seven-year-old doesn't always want to do the same things as an almost-two-year-old, and that's perfectly reasonable. But for those few minutes, drinking pretend tea and fake, unappetizing soup, all four of us were engaged. No one asked to play with my phone. Facebook notifications didn't call to me for attention. No screens came between us and our silly game. It was just me and my boys.

When you take away all the other possibilities, all the other things you "could" be doing right now - whether it's paid work, house work, or Candy Crush (er...yes, guilty on all counts) - a simple pretend tea party brings the whole family to the table.

Thursday, August 8, 2013

In March, we talked about Nursing through Stomach Flu. Breastfeeding your baby through a stomach virus is a gift you can give your child. Breastfeeding when you have a stomach virus can be incredibly difficult, especially when your baby has recovered and you've just started feeling ill. Fortunately, stomach viruses tend to pass through quickly - within 24 to 48 hours, typically - and as long as you can stay reasonably hydrated, you all should come through it with no more than a little extra laundry to show for it. Ideally.

On a similar topic, what about stomach flu and pregnancy?

My husband and I came down with something Sunday and Monday. We're not sure if it's something we ate or a stomach virus. The three kids all seem fine (crossing fingers), but we were both miserable. It didn't last long - less than 24 hours - but it wasn't pretty. Taking care of three kids and enduring the third trimester with a tender stomach is not one of the more fun Mondays I've had. I spent quite a lot of the day lying down and let the kids watch a lot of TV. The two hardest parts of childcare when you're sick are (can you guess?) changing poopy diapers and preparing food that you've no intention of eating. Of course, I had the privilege of doing both, multiple times that day.

I've had stomach flu while pregnant before (indeed, I was early in my pregnancy in March when the above-linked post was written), but never in the third trimester. This baby kicks a lot and kicks hard - I don't remember if my other three were this active at six months' gestation. What I can tell you is that having a baby kick you when you already have a stomach ache adds a whole new dimension to feeling crummy! What a bizarre and unwelcome sensation! (Although, knowing he was moving around in there and kicking happily was also reassuring.)

Here's the thing about stomach upset and pregnancy: Prolonged dehydration can be harmful to the developing baby, and it can make you feel worse. One day of vomiting/diarrhea isn't generally a big problem but if you go longer than 24 hours without being able to keep fluids down, you definitely want to be seen. The ER is an option in this case, if you're doing very poorly, as you may need IV fluids to sufficiently re-hydrate you.

Things to watch out for:
- Make sure you're feeling your baby move regularly (if you've started feeling movement). A baby who isn't moving is a baby who might need attention.
- Regular contractions. Sometimes, if your body is stressed and you're near term, you can go into early labor. If you notice contractions becoming stronger or regular, especially if you feel more than four in an hour, call your provider immediately and find out if you should come in or go to a hospital.

Obviously, if you ever have a concern regarding your health during pregnancy, contact your OB or midwife for advice!

A short note about food poisoning:
Typically, food poisoning that affects mom will not directly harm the baby. However, there are a few forms of food poisoning that can be harmful to the developing fetus. If you suspect you have one of these infections, please contact your care provider immediately! The main problematic infection is Listeriosis. Listeria is a bacteria found mainly on processed meats and cheeses and in unpasteurized milk and dairy products. Listeria poses little danger to adults, but it can cause serious harm to a developing fetus. See this WebMD article for specific information.

Friday, August 2, 2013

Pregnancy can bring on some very strange dreams. I remember when I was pregnant with my first, I dreamed I had given birth to a kitten and was nursing it. I then read another mother's story that she had dreamed of giving birth to spiders! I preferred the kitten dream.

If I'm experiencing any unrelated anxiety, it often translates in my dreams as pregnancy or delivery-related worries. This is especially true if I'm in any way uncomfortable as I sleep or if I'm experiencing any mild contractions (these are called Braxton-Hicks and are perfectly normal and of no concern unless they become progressively painful and more regular - more than four in a one-hour period).

The other night was one of those nights.

I dreamed that my baby was kicking so strongly that I could actually see individual toes through my skin. I then dreamed that I could actually see about half his body. My doctor informed me that I had a rare condition in which the baby was actually emerging through a hole in my uterus, and I required an immediate c-section. The next "scene" in the dream, I had just come out of the c-section, and was sitting at what looked like a cafeteria table, slightly uncomfortable. I asked the nurse if I could please lie down. She told me they had had to do an experimental new type of c-section in which the incision was horizontally across the top of my uterus instead of the more traditional low-transverse cut (also called the "bikini cut"). She said they didn't have a bed available, but that they'd give me one as soon as they could. I then asked if I could have my baby because I wanted to nurse him as soon as possible. She assured me they would bring him to me. Then I was holding my baby, who had a head of straight, black hair (my husband and I both have light-brown/reddish hair, and our three sons are two redheads and a blond) and looked slightly Asian in appearance (quite surprising, since my husband and I are both of European ancestry!).

That's about all I remember of the dream, but when I woke up, I found I was lying flat on my back and my arms were tingling. I had probably been in that position for a while and was experiencing the vague symptoms of reduced blood pressure and blood flow caused by the weight of my uterus on my vena cava. I rolled to my side and felt instantly better.

It's interesting, this dream, because the fact of the c-section itself didn't bother me at all. I was much more anxious about getting to meet and nurse my baby. I think my brain is coming to terms with knowing that I will in all likelihood have a successful and uneventful VBAC, but if a c-section is necessary, then it's necessary and isn't the end of the world. I also think I have so much on my mind right now that thinking about the birth is actually fairly low on the list of immediate concerns. Hey, it's nearly three months away right now. I've got stuff to worry about in the next few weeks totally unrelated to the birth of this baby. Indeed, my pregnancy is more of an inconvenience than anything! (Not that I'm not excited about the new baby!) In fact, in the dream I was already planning how I would present my birth story on the blog, both excited and slightly embarrassed to report on my c-section.

Obviously, I'm only about 28 weeks pregnant right now and have no intention of delivering this baby for another 11 to 12 weeks. But I know I'm definitely entering the third trimester, with all its associated discomforts and worries, and my subconscious is surely preparing itself for the birth, even if I have other things to occupy my conscious mind.